Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis
Comparison of three cut-offs to diagnose clinically significant portal hypertension by liver stiffness in chronic viral liver diseases: a meta-analysis
复制标题
慢性病毒性肝病中通过肝硬化诊断临床显着门脉高压的三种临界点的比较：一项荟萃分析
DOI：
10.1007/s00330-018-5478-z
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发表时间：
2018-12-01
影响因子：
5.9
通讯作者：
Kitson, Matthew
中科院分区：
文献类型：
--
作者：
Song, Jinzhen;Ma, Zida;Kitson, Matthew
背景基于瞬时弹性成像的肝脏硬度值（TE-LSV）已被用于评估临床显著的门静脉高压症（CSPH）。CSPH的病因是决定TE-LSV的重要因素。有选择cut-off values.AimsThis study performed a meta analysis to comparison the three most widely used cut-off values（around 13.6 kPa，18 kPa and 22 kPa）of TE-LSV for the diagnosis of CSPH in patients with chronic viral liver diseases.MethodsThe PubMed，奥维德，Web of Science and科克伦图书馆数据库进行了检索。提取了每个纳入研究中临界值约为13.6 kPa、18 kPa和22 kPa的诊断数据。双变量模型进行估计汇总的敏感性，特异性，阳性似然比（LR+）和阴性似然比（LR-）。13.6 kPa、18 kPa和22 kPa附近临界值的合并灵敏度为0.96（95% CI 0.93-0.97），0.85（0.81-0.89）和0.74（0.66-0.80）;合并特异性分别为0.60（0.47-0.75）、0.80（0.71-0.87）和0.94（0.86-0.97）。合并LR+值为2.4（1.6-3.7）、4.4（2.9-6.8）和11.5（5.5-23.5），截止值分别约为13.6 kPa、18 kPa和22 kPa，合并LR值为0.07结论13.6kPa（高敏感性）和22 kPa（高特异性）的临界值可分别作为CSPH的筛选和确诊工具。结论瞬时弹性成像肝硬度可用于门静脉高压的诊断，不同临界值的比较可为临床决策提供更多信息，临界值13.6 kPa可有效排除有临床意义的门静脉高压（CSPH），临界值22 kPa可有效确诊CSPH。
BackgroundTransient elastography-based liver stiffness value (TE-LSV) has been investigated for assessing clinically significant portal hypertension (CSPH). The aetiology of CSPH is an important factor determining TE-LSV. There is insufficient evidence for selecting cut-off values.AimsThis study performed a meta-analysis to compare the three most widely used cut-off values (around 13.6 kPa, 18 kPa and 22kPa) of TE-LSV for the diagnosis of CSPH in patients with chronic viral liver disease.MethodsThe PubMed, Ovid, Web of Science and Cochrane Library databases were searched. Diagnostic data for cut-off values around 13.6 kPa, 18 kPa and 22 kPa in each included study were extracted. The bivariate model was performed to estimate pooled sensitivity, specificity, positive likelihood ratio (LR+) and negative likelihood ratio (LR-).ResultsEleven studies assessing 910 patients were included in this meta-analysis. Pooled sensitivities of cut-off values around 13.6 kPa, 18 kPa and 22 kPa were 0.96 (95% CI 0.93–0.97), 0.85 (0.81–0.89) and 0.74 (0.66–0.80), respectively; pooled specificities were 0.60 (0.47–0.75), 0.80 (0.71-0.87) and 0.94 (0.86–0.97), respectively. Pooled LR+ values were 2.4 (1.6–3.7), 4.4 (2.9–6.8) and 11.5 (5.5–23.5) for cut-off values around 13.6 kPa, 18 kPa and 22 kPa, respectively, for pooled LR- values of 0.07 (0.04–0.13), 0.17 (0.12–0.25) and 0.28 (0.22–0.36), respectively.ConclusionCut-off values around 13.6 kPa (high sensitivity) and 22 kPa (high specificity) could be used as screening and confirmation tools, respectively, in the diagnosis of CSPH. Overall, the cut-off value around 22 kPa showed the best performance.Key PointsTransient elastography-based liver stiffness could be used to diagnose portal hypertension.Comparison of certain cut-off values would provide more information for clinical decision-making.Cut-off around 13.6 kPa was able to exclude clinically significant portal hypertension (CSPH) effectively.Cut-off around 22 kPa was able to confirm CSPH effectively.